Healthcare Provider Details

I. General information

NPI: 1528704988
Provider Name (Legal Business Name): GO SMILE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5745 PARK BLVD N
PINELLAS PARK FL
33781-3332
US

IV. Provider business mailing address

5745 PARK BLVD N
PINELLAS PARK FL
33781-3332
US

V. Phone/Fax

Practice location:
  • Phone: 727-698-6684
  • Fax:
Mailing address:
  • Phone: 727-698-6684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY LYNNE CATALDO
Title or Position: PEDIATRIC DENTIST/ CO-OWNER
Credential: DMD
Phone: 727-698-6684